<html>
<head>
{php}html_header_show();{/php}
{literal}

 <style type="text/css" title="mystyles" media="all">
<!--
td {
	font-size:12pt;
	font-family:helvetica;
}
li{
	font-size:11pt;
	font-family:helvetica;
	margin-left: 15px;
}
a {
	font-size:11pt;
	font-family:helvetica;
}
.title {
	font-family: sans-serif;
	font-size: 12pt;
	font-weight: bold;
	text-decoration: none;
	color: #000000;
}

.form_text{
	font-family: sans-serif;
	font-size: 9pt;
	text-decoration: none;
	color: #000000;
}

-->
</style>
{/literal}
</head>
<body bgcolor="{$STYLE.BGCOLOR2}">
<p><span class="title">History of Present Illness</span></p>
<form name="soap" method="post" action="{$FORM_ACTION}/interface/forms/hpi/save.php"
 onsubmit="return top.restoreSession()">
<table>
	<tr>
		<td align="left">Location</td>
		<td width="90%">
			<textarea name="location" cols="60" rows="6">{$data->get_location()}</textarea>
		</td>
	</tr>

	<tr>
		<td align="left">Quality</td>
		<td width="90%">
			<textarea name="quality" cols="60" rows="6">{$data->get_quality()}</textarea>
		</td>
	</tr>

	
	<tr>
		<td align="left">Severity</td>
		<td width="90%">
			<textarea name="severity" cols="60" rows="6">{$data->get_severity()}</textarea>
		</td>
	</tr>

	
	<tr>
		<td align="left">Duration</td>
		<td width="90%">
			<textarea name="duration" cols="60" rows="6">{$data->get_duration()}</textarea>
		</td>
	</tr>

	
	<tr>
		<td align="left">Timing</td>
		<td width="90%">
			<textarea name="timing" cols="60" rows="6">{$data->get_timing()}</textarea>
		</td>
	</tr>

	
	<tr>
		<td align="left">Context</td>
		<td width="90%">
			<textarea name="context" cols="60" rows="6">{$data->get_context()}</textarea>
		</td>
	</tr>

	
	<tr>
		<td align="left">Modifying Factors</td>
		<td width="90%">
			<textarea name="factors" cols="60" rows="6">{$data->get_factors()}</textarea>
		</td>
	</tr>

	
	<tr>
		<td align="left">Associated Signs and Symptoms</td>
		<td width="90%">
			<textarea name="signs" cols="60" rows="6">{$data->get_signs()}</textarea>
		</td>
	</tr>
	
	<tr>
		<td>
			<input type="submit" name="Submit" value="Save Form">
		</td>
		<td>
			<a href="{$DONT_SAVE_LINK}" class="link">[Don't Save]</a>
		</td>
	</tr>
</table>
<input type="hidden" name="id" value="{$data->get_id()}" />
<input type="hidden" name="pid" value="{$data->get_pid()}">
<input type="hidden" name="process" value="true">
</form>
</body>
</html>
